Jason Industries Form 3 Jason Industries / KEITH ALAN WALZ ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

WALZ KEITH ALAN

(Last) (First) (Middle)

833 EAST MICHIGAN STREET

SUITE 900

(Street)

MILWAUKEE WI 53202

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
02/27/2018

3. Issuer Name and Ticker or Trading Symbol
Jason Industries, Inc. [ JASN ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
SVP & GM-Finishing

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	5,000	D
Common Stock	10,722	I	By IRA

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Restricted Stock Units	(1)	(1)	Common Stock	2,500	(1)	D
Restricted Stock Units	(2)	(2)	Common Stock	50,000	(2)	D

Explanation of Responses:

1. The time-vesting restricted stock units vest in equal one-third (1/3) installments on each of the first three (3) anniversaries following February 4, 2016, provided that the reporting person has not been terminated prior to the applicable vesting date.

2. The time-vesting restricted stock units vest in two equal installments with the first vesting date being January 5, 2019 and the second vesting date being July 5, 2020, provided that the reporting person has not been terminated prior to the applicable vesting date.

Remarks:

	/s/ James M. Reeves as attorney-in-fact	02/28/2018
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.